Role of Superb Microvascular Imaging in Differentiating Between Malignant and Benign Solid Breast Masses

In this study, the penetrating vessels and the microvascular morphologic and distribution features of 85 breast masses were evaluated by monochromatic superb microvascular imaging (mSMI). We found that mSMI visualized more vessels within the breast masses and depicted vessel complexity in more detail without the use of contrast agents. The accuracy of mSMI is equal to that of contrast-enhanced ultrasonography and superior to the accuracy of color Doppler flow imaging and power Doppler imaging in discriminating malignant and benign breast masses. Introduction: The purpose of this study was to evaluate the diagnostic performance of superb microvascular imaging (SMI) in breast lesions. Materials and Methods: Eighty-five solid breast lesions were studied with color Doppler flow imaging (CDFI), power Doppler imaging (PDI), monochromatic SMI (mSMI), and contrast-enhanced ultrasonography (CEUS). The penetrating vessels (PVs) and microvascular morphologic and distribution features of the breast tumors were evaluated for each modality. Results: The diagnostic accuracies of CDFI, PDI, mSMI, and CEUS were calculated and compared. Surgical pathologic analysis showed 47 benign and 38 malignant lesions. Compared with CDFI and PDI, mSMI and CEUS detected more PVs in breast lesions. The microvascular architecture showed significant differences between benign and malignant lesions. Benign lesions mainly displayed avascular, line-like, and branch-like patterns, and malignant lesions tended to display root hair-like and crab claw-like patterns. mSMI and CEUS identified more root hair-like and crab claw-like patterns in malignant lesions than CDFI and PDI. The sensitivity, negative predictive value, and accuracy of mSMI findings in diagnosing malignancy based on PVs and vascular patterns were both higher than those of CDFI and PDI. Conclusions: mSMI is equal to CEUS and superior to CDFI and PDI in identifying microvascular and discriminating malignant and benign breast masses. (C) 2020 Elsevier Inc. All rights reserved.